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Treatment of gastrointestinal disease in systemic sclerosis (scleroderma)

Authors
Stephanie A Kaye-Barrett, MD
Christopher P Denton, MD
Section Editors
John S Axford, DSc, MD, FRCP, FRCPCH
Nicholas J Talley, MD, PhD
Deputy Editors
Monica Ramirez Curtis, MD, MPH
Shilpa Grover, MD, MPH

INTRODUCTION

Nearly 90 percent of patients with systemic sclerosis (SSc) have some degree of gastrointestinal (GI) involvement, and approximately one-half are symptomatic [1,2]. Although the esophagus is the most frequently affected part of the GI tract, any part of the GI tract may be involved. Severe involvement occurs in less than 10 percent of patients and is associated with an unfavorable prognosis [3,4]. This topic will review the management of GI disease associated with SSc. Our approach is generally consistent with clinical practice guidelines for the management of common SSc manifestations affecting the GI tract [5]. The pathogenesis, pathology, clinical manifestations, and diagnosis of GI manifestations of SSc are discussed separately. (See "Gastrointestinal manifestations of systemic sclerosis (scleroderma)".)

OROPHARYNGEAL DISEASE

The management of oral manifestations of systemic sclerosis (SSc) is largely supportive. Regular dental hygiene is necessary to help prevent dental caries. Patients with decreased oral aperture may be able to improve gingival help using adaptive oral hygiene devices (eg, flossers, oscillating-rotating toothbrushes) combined with facial exercises to increase the oral mouth opening [6,7]. Artificial saliva may be used in patients who also have sicca syndrome. (See "Treatment of dry mouth and other non-ocular sicca symptoms in Sjögren's syndrome", section on 'Saliva substitutes'.)

ESOPHAGEAL DISEASE

Management of esophageal disease is largely directed toward the amelioration of symptoms of heartburn and dysphagia, which may be due to esophageal dysmotility or gastroesophageal reflux disease (GERD) and its complications (eg, strictures, esophagitis).

Gastroesophageal reflux — The management of GERD in patients with systemic sclerosis (SSc) is similar to that in patients without SSc. However, patients with SSc often have more severe symptoms.

While lifestyle and dietary modification should be recommended in all patients with GERD, these measures are usually inadequate by themselves. These measures include elevation of the head of the bed and selective elimination of dietary triggers (see "Medical management of gastroesophageal reflux disease in adults", section on 'Lifestyle and dietary modification'). Calcium channel blockers and anticholinergic agents, which may be used to treat other manifestations of SSc, can potentially worsen reflux.

                 

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Literature review current through: Nov 2016. | This topic last updated: Thu Nov 10 00:00:00 GMT+00:00 2016.
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